3513 Cimarron Boulevard, Corpus Christi TX 78414 |
(361) 991-5146
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Catechesis of the Good Shepherd
EDGE 6th-8th
High School Youth Ministry
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EDGE - Registration
Participant Information
Youth Name
First Name*
Middle Name
Last Name*
NickName
Date of Birth
Required*
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Sex
Required*
Female
Male
Grade
Required*
Please make a selection
6TH
7TH
8TH
Freshman
Sophmore
Junior
Senior
School
Required*
Address
Street 1*
Street 2
City*
State*
-- select --
Alabama
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip*
Expected High School Graduation Year
Required*
Please make a selection
2023
2024
2025
2026
2027
T-Shirt Size (Adult)
Required*
EXTRACURRICULAR ACTIVITIES
Parent/Guardian Information
Mail should be addressed to:
Required*
Parents
Mother
Father
Other (Specify)
Other (Specify)
FATHER
FATHER'S INFORMATION
Name
First Name
Last Name
Phone
-
-
--select--
Home
Mobile
Work
Address
Street 1
Street 2
City
State
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip
E-mail
MOTHER
MOTHER'S INFORMATION
Name
First Name
Last Name
Phone
-
-
--select--
Home
Mobile
Work
Address
Street 1
Street 2
City
State
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip
E-mail
REGISTERED AT:
Required*
Please make a selection
ST PHILIP
ANOTHER PARISH (PLEASE SPECIFY)
NOT REGISTERED AT ANY PARISH
PLEASE SPECIFY WHAT PARISH YOU ARE REGISTERED AT:
EMERGENCY CONTACT INFORMATION
In case of an emergency whom should we contact if we are unable to reach parent/guardian?
Name
First Name*
Last Name*
RELATIONSHIP
Required*
Phone
Required*
-
-
--select--
Home
Mobile
Work
Name
First Name*
Last Name*
RELATIONSHIP
Required*
Phone
Required*
-
-
--select--
Home
Mobile
Work
HEALTH INFORMATION AND SPECIAL NEEDS
All information will be held in strict confidence
DOCTOR'S NAME
Required*
Phone
Required*
-
-
INSURANCE COMPANY NAME
Required*
MEDICAL INSURANCE ID #
Required*
CARDHOLDERS NAME
Required*
GROUP NUMBER
Required*
PARTICIPANTS ALLERGIES
IF ANY, INCLUDING MEDICATIONS AND FOODS*
PARTICIPANTS CHRONIC MEDICAL PROBLEMS
(e.g. diabetes, epilepsy)*
PARTICIPANTS OTHER PHYSICAL RESTRICTIONS
IF ANY*
OTHER NOTES
PARENT/GUARDIAN DUTIES
WE NEED ADULT VOLUNTEERS!
Please indicate how you can help!
Set-up for Sunday Youth Ministry Nights
Middle School CORE TEAM
High School CORE TEAM
Kitchen Team
Special Events Volunteer
PHOTOGRAPHY CONSENT
PHOTOGRAPHY CONSENT
As parent/guardian, I understand that photos and video (individual and group) will be taken during youth group events, and I give permission for my son's/daughter's picture to be used for printed or online promotional materials
PHOTOGRAPHY CONSENT
Required*
I AGREE
I DISAGREE
LIABILITY WAIVER
I agree on behalf of myself, my child’s other parent if known or living, my child named herein, our heirs, successors, and assigns, to release and hold harmless and defend the Diocese of Corpus Christi, St. Philip the Apostle Catholic Church (its pastors, youth minister, principal, other agents, etc.) or any representatives associated with any ongoing scheduled activities from all damages, claims, suits, expenses and payments for injury to my child and/or property, including all damages, claims, suits, expenses and payments resulting from the negligence of the Diocese of Corpus Christi, St. Philip the Apostle Catholic Church, and/or their officers, directors and employees. This liability waiver is effective from date of signature to June 1,2023.
LIABILITY WAIVER
Required*
I agree
Date
Required*
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
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